<%@ page language="java" contentType="text/html; charset=UTF-8" pageEncoding="UTF-8"%>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c"%>
<html>

<head>
<title>网格管理</title>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<jsp:include page="/WEB-INF/views/config/include.jsp" />

<style>
.title {
	width: 100%;
	display: inline-block;
	height: 30px;
	text-align: center;
	line-height: 30px;
}
span {
	display: inline-block;
	height: 30px;
	text-align: center;
	line-height: 30px;
}
</style>
</head>
<body class="body">
	<div class="container">
		<!-- 选择户主类型 -->
		<form class="form" action="/gather/user/add" method="POST" id="home_h5">
			<pf:token /> 
			<input type="hidden" id="openId" name="openId" value="${openid}">
			<input type="hidden" id="gatherAreaId" name="gatherAreaId" value="${area.id}">
			<input type="hidden" id="gatherAreaName" name="gatherAreaName" value="${area.gatherAreaName}">
			<div class="title">
				<h3>业主信息申报</h3>
			</div>
			<div>
				<span>姓名：</span><br>
				<input class="form-control" type="text" name="userName" placeholder="请输入姓名">
			</div>
			<div>
				<span>手机号：</span><br>
				<input class="form-control" type="text" name="userPhone" placeholder="请输入手机号">
			</div>
			<div>
				<span>房间号码</span><br> <input class="form-control" type="text" name="houseNumber" placeholder="例如：1-123">
			</div>
			<div>
				<span>是否有过湖北接触史：</span><br> <select class="form-control" name="isContact">
					<option value="否">否</option>
					<option value="是">是</option>
				</select>
			</div>
			<div>
				<span>身体有哪些不适：</span><br>
				<input class="form-control" type="text" name="symptoms" placeholder="例如：头疼，咳嗽">
			</div>
			<div>
				<span>业主类型：</span><br> <select class="form-control" name="identityName">
					<option value="业主">业主</option>
					<option value="租户">租户</option>
				</select>
			</div>
			<div>
				<span>家人现在是否有异常症状：</span><br> <select class="form-control" name="familyIllName">
					<option value="家人暂无异常症状">家人暂无异常症状</option>
					<option value="有家人出现不适症状">有家人出现不适症状</option>
					<option value="有家人已经确证">有家人已经确证</option>
				</select>
			</div>
			<div>
				<span>最近十四天去过哪些城市：</span><br>
				<input class="form-control" type="text" name="travelCity" placeholder="例如：河南，北京">
			</div>
			<div>
				<span>申报时间</span><br> <input class="form-control" type="text" name="time" value="${time}" readonly>
			</div>
（友情提示：隐瞒申报将承担法律责任！！！）
		<input type="button" class="btn btn-primary form-control" onclick="btnonclick()" value="提交"><br>
		</form>
	</div>
	
<script>
function btnonclick(){
	home_h5.submit();
}
</script>
</body>
</html>